Medication Use and Quality of Life in Older Adults with Personality Disorders

Medication use is increasing in psychiatric populations, particularly those with personality disorders (PDs). Older adults with PDs are at higher risk for adverse drug reactions (ADRs), which may interfere with daily functioning.

This study aimed to describe medication use and health-related quality of life (HR-QOL) in older adults with PDs compared with control groups and to evaluate predictors of medication use and HR-QOL.

The PhArmacotherapy aND pOlypharmacy in oldeR Adults (PANDORA) study is a Dutch multicenter cross-sectional study including 77 older adults with PDs (OA-PD), 54 younger to middle-aged adults with PDs (A-PD), and 88 healthy older adults (OA-H). Medication use was assessed via participant questionnaires and verified against electronic health records for patients. HR-QOL was measured using the EQ-5D-3L (visual analog scale [VAS] and utility score). Statistical analyses were performed with general linear models.

Polypharmacy (≥ 5 medications daily) was present in 55.8% of the OA-PD group. OA-PD used more psychotropic and somatic medications than OA-H (b = - 1.555, p < 0.001 and b = - 1.341, p < 0.001, respectively) and A-PD (b = - 0.753, p < 0.001 and b = - 2.128, p < 0.001, respectively). Medication use was predicted by the number of psychiatric and somatic diagnoses. OA-PD reported lower EQ-VAS (b = 20.659, p < 0.001) and lower EQ-utility scores (b = 0.351, p < 0.001) compared with OA-H. ADRs, rather than the number of medications, significantly predicted HR-QOL (p < 0.001).

Both somatic and psychotropic medication use is highly prevalent in OA-PD. OA-PD report lower HR-QOL compared with OA-H, in which ADRs may be a mediating factor. These findings underline the importance of regular medication reviews in older adults with PDs. Future research should investigate longitudinally the effect of deprescribing on HR-QOL in this population.